A Model Living Will
ADVANCE MEDICAL DIRECTIVE
A First Draft of a Model Living Will
Disclaimer: This is a draft Advance Medical Directive (AMD) prepared on the basis of what we understood from the Supreme Court Judgment. It is meant to be a first draft and indicative in nature. We strongly recommend seeking sound legal opinion before writing or executing an actual Living Will.
As per the Supreme Court of India’s judgment dated March 9, 2018, the following Advance Medical Directive has been executed by me to lay down clear and specific instructions during the course of my treatment, as well as to strengthen the mind of the treating doctors that they are acting in a lawful manner.
I ___(name)__ am an adult of a sound and healthy state of mind and in a position to communicate, relate and comprehend the purpose and consequences of executing this document.
This AMD has been voluntarily executed without any coercion or inducement or compulsion and after having full knowledge or information.
I certify that this AMD has the characteristics of an informed consent given without any undue influence or constraint.
The purpose of this AMD in writing is to clearly specify the situations when medical treatment, having the effect of delaying the process of my death may be withdrawn or when no specific medical treatment is to be provided. This covers treatments, which if given, may cause me pain, anguish and suffering and further put me in a state of indignity.
In case the situation so arises that I become terminally ill or am reduced to a persistent vegetative state I may be permitted to accelerate the process of natural death which would have already commenced.
If at any time, I reach the stage of terminal illness, and go into a coma with no reasonable expectation of regaining consciousness, or reach a persistent vegetative stage with no reasonable expectation of regaining significant cognitive functioning, or have a disease state from which I have no reasonable expectation of coming back to a life with reasonable quality of life, I should be deemed to decline to receive life-sustaining treatment.
I request that this ‘AMD’ should be honoured by my family members and physicians as the final expression of my legal right to refuse medical or surgical treatment and accept the consequences of such refusal.
In addition, and as a supplementary alternative, I hereby appoint Mr./Mrs. ________ who, in the event of my becoming incapable of taking decision at the relevant time, is hereby authorised to give consent to refuse or withdraw medical treatment in a manner consistent with this AMD.
I may at any time revoke these specific terms/instructions spelt out absolutely clearly and unambiguously by me in this AMD.
I have understood fully the consequences of executing this AMD.
This AMD shall not be applicable to the treatment in question if there are reasonable grounds for believing that circumstances existed which I did not anticipate at the time of the AMD and which would have affected my decision had I anticipated them.
I declare that the person who signed or acknowledged this document is personally known to me, that he/she signed or acknowledged this Living Will Declaration in my presence, and that he/she appears to be of sound mind and under no duress, fraud, or undue influence.
______________________ ________________________ First Witness Signature Second Witness Signature ______________________ ________________________ First Witness Full Name Second Witness Full Name ______________________ ________________________ ______________________ ________________________ First Witness Address Second Witness Address
In the event that I execute more than one valid AMD my most recently signed AMD should be considered as the last expression of my wishes and should be given effect to.
As per the directions of the Hon’ble Supreme Court this AMD has been signed by me in the presence of two independent attesting witnesses, and countersigned by the jurisdictional Judicial Magistrate of First Class (JMFC) so designated by the concerned District Judge.
I understand the full importance of this AMD and am fully competent to make it.
Conditions to be followed for implementation of the AMD:
Euthanasia: Concerns and Considerations
“This Court has to consider euthanasia and its impact ‘not only at an individual level’, but also at the ‘institutional, governmental and societal levels’. The impact has to be analysed not only in the context of the present era, but has to be contemplated for the future as well. The judge is not a soothsayer. Nor does the law have predictive tools at its command which can approximate those available to a scientist. Constitutional principle must have an abiding value. It can have that value if it is firmly grounded in the distilled experience of the past, is flexible to accommodate the concerns of the present and allows room for the unforeseeable future. The possibility of the abuse of euthanasia and the effect that legalising euthanasia would have on intangible societal fabrics and institutions is of utmost concern.” --- Justice Chandrachud.